Sueda Shozo, Kohno Hiroaki
Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 Choume 1-1, Niihama, Ehime, 792-0042, Japan.
Department of Cardiology, Tsukazaki Hospital, Himeji, Japan.
Heart Vessels. 2018 Feb;33(2):126-133. doi: 10.1007/s00380-017-1046-8. Epub 2017 Sep 13.
Coronary artery spasm is involved in the pathogenesis of various cardiac disorders. We investigated patients with a history of syncope who underwent elective coronary angiography. We retrospectively analyzed 5781 consecutive patients who had diagnostic or follow-up angiography during a 26-year period. During this period, we found 95 patients with a history of syncope before elective coronary angiography. Pharmacological spasm provocation testing was performed in 64 patients with a history of syncope (<1 year). Positive pharmacological response was observed in 48 patients, while the remaining 16 patients had negative tests. Positive spasm was defined as a transient ≥90% narrowing with ischemic electrocardiographic changes. Among the 64 patients, definite coronary spastic angina (CSA) was found in 35 patients (54.7%) and suspected CSA was found in 13 patients (20.3%). Among the 35 patients with definite CSA, 22 patients (62.9%) had chest symptoms before syncope, but 13 (37.1%) had no chest symptom before syncope. No difference in clinical characteristics was observed between the two groups. Focal spasm during pharmacological spasm provocation tests was significantly higher in patients with chest symptoms than in those without chest symptoms before syncope (54.3 vs. 12.0%, p < 0.002). CSA was observed in 75.0% of patients with a history of syncope (<1 year). Thirteen patients with definite CSA had neither chest pain nor chest pressure before syncope. We should therefore investigate coronary artery spasm as a potential etiology in patients with a history of syncope.
冠状动脉痉挛参与多种心脏疾病的发病机制。我们对有晕厥病史且接受择期冠状动脉造影的患者进行了研究。我们回顾性分析了在26年期间连续进行诊断性或随访性血管造影的5781例患者。在此期间，我们发现95例患者在择期冠状动脉造影前有晕厥病史。对64例有晕厥病史（<1年）的患者进行了药物性痉挛激发试验。48例患者观察到阳性药物反应，其余16例患者试验结果为阴性。阳性痉挛定义为伴有缺血性心电图改变的短暂性≥90%狭窄。在这64例患者中，35例（54.7%）被诊断为明确的冠状动脉痉挛性心绞痛（CSA），13例（20.3%）为疑似CSA。在35例明确诊断为CSA的患者中，22例（62.9%）在晕厥前有胸痛症状，但13例（37.1%）在晕厥前无胸痛症状。两组患者的临床特征无差异。有胸痛症状的患者在药物性痉挛激发试验期间的局灶性痉挛明显高于晕厥前无胸痛症状的患者（54.3%对12.0%，p<0.002）。有晕厥病史（<1年）的患者中75.0%观察到CSA。13例明确诊断为CSA的患者在晕厥前既无胸痛也无胸部压迫感。因此，我们应将冠状动脉痉挛作为有晕厥病史患者的潜在病因进行研究。
